The present invention relates generally to maintaining medical records of patients within a health care organization and, more specifically, to maintaining and updating medical records in a computer network system that also provides concurrent billing records reflective of the value of the services rendered.
Record keeping is critically important in the health care industry. Computerized health record data bases have been provided in the health care industry in recent years. The use of these data bases allows for a record of the patient to be maintained, which aids the health care provider in evaluating the patient's health and treatment history with that particular health care organization. Further, the recording of health care history for a group of patients is useful in conducting medical research for individuals having like symptoms and like treatments. Further still, the advantage of having computerized data bases aids in managing costs and providing billing records for the health care provider, the patient, the insurance providers, as well as any governmental health care program such as for example, Medicare.
In the past, the input of medical history information for a given patient was provided either by the health care provider directly via a recording system or was transcribed by a staff member from a physician's notes of a visit with a particular patient. These records would then be placed within a computerized data base for later recall. However, it was not easy to discern what were the costs to the patient for the treatment provided by the physician or for the services rendered by the health care organization in such a transcription. Even with this method and system for recording patient histories within a common data base, there is still a need to provide accurate billing information to the patient and to the doctor at any given time. The system provided for a billing invoice to be provided, but only after the doctor's notes had been sent to the accounting department and billing records personnel, which would either be discussed with the patient prior to leaving or sent to the patient at a later date following the actual visit. Neither the doctor nor the patient knew what the costs of the services would be until after the visit had been concluded and the patient had visited with the billing personnel. Further, the billing personnel would then have to translate the doctor's notes into codes that would be acceptable for insurance billing purposes, which would include codes to private insurance as well as codes to public insurance, such as Medicare. This required that the billing personnel became highly specialized in insurance procedures where the physicians or primary health care providers needed the services of such specialization in order to obtain payment from the insurance providers. If there was trouble with converting the real time medical records into appropriate insurance language, Then the health care organization would be delayed in obtaining revenue from the insurance sources to pay for the covered services.
Improved computerized data entry systems later came along that allowed a physician or health care provider to enter patient medical information during the examination, but that information still needed to be processed by the billing personnel prior to an accounting of services and costs could be given to the patient. It did speed up the recording of the medical records, but did not improve the actual billing and insurance collection process required by the doctors, the patients, and the insurance industry.
Billing code correlation later came along to correlate billing codes with planned or performed medical procedures. Raw codes were directly associated with all the medical procedures performed or planned to be performed with a particular patient examination and then the raw codes were manipulated in such a way as to generate intermediate codes that would later be used to determine the actual billing codes to be used in processing the billing reports to either the patient, the insurance provider, or both. Unfortunately, the billing code correlation approach focuses solely on the physician's Current Procedural Terminology (CPT) medical coding system of the American Medical Association (AMA) for reporting physician's services to the Medicare program. This approach also fails to provide for a real time accounting system that allows a doctor to view the actual costs associated with the services rendered in discussing these fees with the patient during the actual visit.
Accordingly, there is a need for a computerized medical records and billing system that allows for a doctor to view billing information on a real time basis with respect to the entry of services rendered at the time of the patient's actual visit. Furthermore, what is needed is a computerized billing system and medical records system that allows for a patient to consult with the doctor during the procedure to determine not only the best possible medical service for the patients needs, but also the most effective and cost efficient medical service for the patient's budget or means. Further still, what is needed is a medical records and billing system that allows a doctor to understand all phases of information entry into the data base that includes not only the patient information and treatment and diagnosis, but also the billing codes used for both private insurance and government insurances, such as Medicare. It is desirable that this system be offered in a useful manner that provides a graphical user interface to guide the health care provider and billing personnel through easy to understand steps that provide not only useful medical history records, but also clear and concise billing records for both the insurance industry and the patient.